Reproductive Medicine Specialists Research Articles

Behavior, attitude, perception, and knowledge regarding fertility preservation among Chinese pediatric oncologists: a survey in China.

Clinical specialists are supposed to inform childhood cancer patients of infertility risk and conduct fertility preservation (FP). However, little is known about whether doctors in China are fully prepared. This study aimed to investigate behavior, attitude, perception, and knowledge regarding FP among pediatric oncological specialists in a nation wide survey, to set the stage for improvements in current clinicalpracticepatterns. This study was conducted on physicians and surgeons specialized in pediatric oncology using a questionnaire through theWeChat platform. The behavior, attitude, perception, and knowledge were assessed by Likert questions and results were quantified to obtainscores. Data were then described and analyzed using R and GraphPad. Totally 373 specialists in pediatric tumors were included in the analysis. Hematologists, oncological surgeons, and reproductive medicine specialists won most trusts to be responsible for FP job. Most respondents did not have habits of delivering FP information or cooperating with FP specialists during treatment though they were well equipped with FP knowledge and desired for uniform national guideline for FP procedures. The severity of illness was regarded as the primary barrier of FP delivery. When a doctor was more educated and experienced, he was more likely to have better performance in FP. The total score, the knowledge score, and the single score concerning frequency of patients' inquiry showed aggregational trend on geographic distribution. Chinese pediatric oncologists demonstrated unsatisfactory practice behaviors based upon this self-reporting survey, although their attitude towards FP was generally positive.

P-405 Effects of intrauterine perfusion of autologous platelet-rich plasma on recurrent implantation failure in frozen-thawed embryo transfer: a meta-analysis of randomized controlled trials

Abstract Study question We aimed to evaluate the effect of the platelet-rich plasma （PRP) on pregnancy outcomes in patients with RIF undergoing frozen-thawed embryo transfer (FET). Summary answer Intrauterine infusion of PRP might have more beneficial effects on pregnancy outcomes in RIF patients undergoing FET. What is known already Immunological therapies are of great interest to specialists in reproductive medicine. The immune therapies use intrauterine infusion (i.e., PRP, PBMC, G-CSF, and hCG) for endometrial immunomodulation. Despite the limited number of publications available, the results are encouraging. In the network meta-analysis, PRP, PBMC, C-GCSF, and hCG administration all significantly increased embryo implantation and clinical pregnancy compared to controls. Additionally, PRP administration resulted in a higher live birth rate than the control. This year, more research has focused on PRP as an innovative method to treat RIF. Study design, size, duration Medline, Embase, and Cochrane Controlled Register of Trials (CENTRAL) were searched from inception to July 29, 2023. The randomized controlled trials (RCTs) reporting on pregnancy outcomes of women with RIF who were administered PRP undergoing FET were included. We conducted a meta-analysis where possible using a fixed effects model. The Cochrane Handbook was used to assess the risk of bias for RCTs. Binary outcomes were pooled using risk ratio (RR) with 95% confidence intervals (CIs). Participants/materials, setting, methods Seven RCTs were included with 1,014 RIF women. The final number of women analyzed was 508 with intrauterine infusion PRP and 506 without it. Main results and the role of chance Meta-analysis showed that compared to the controls, the women who received PRP had a significantly higher embryo implantation rate (n = 2, risk ratio (RR) 2.34, 95% CI 1.65 to 3.32; P < 0.00001, I2 = 0%), biochemical pregnancy rate (n = 5, RR 1.94, 95% CI 1.60 to 2.36; P < 0.00001, I2 = 0%), clinical pregnancy rate (n = 7, RR 2.31, 95% CI 1.89 to 2.82; P < 0.00001, I2 = 0%), ongoing pregnancy rate (n = 3, RR 2.70, 95% CI 1.79 to 4.05, P = 0.0004, I2 = 31%), and multiple pregnancy rate (n = 3, RR 2.67, 95% CI 1.07 to 6.68, P = 0.04, I2 = 0%). However, PRP was not attributable to reduce the miscarriage rate (n = 3, RR 1.15, 95% CI 0.40 to 3.35; P = 0.80, I2 = 0%). Limitations, reasons for caution The proportion of small-sample studies included has to some extent affected the validity of the results. There were some variations regarding the PRP preparation process, which may result in a variable composition and concentrations of its different contents. Wider implications of the findings Intrauterine infusion PRP in patients with RIF who underwent FET may improve the pregnancy outcomes assessed in RCTs, including clinical pregnancy and ongoing pregnancy. Therefore, we suggest that PRP be included in endometrial preparation protocols. Trial registration number not applicable

P-363 Reproductive toxicity of new immunobiologic treatments for male patients with melanoma

Abstract Study question Do immunotherapy and targeted therapy for melanoma affect male fertility? Summary answer Immunotherapy and targeted therapy for melanoma affect sperm quality. However, the detrimental effects are only transient. Sperm quality recovers once the treatment is discontinued. What is known already Immune checkpoint inhibitors, such as anti-BRAF and anti-MEK inhibitor, are currently used in melanoma patients to modulate the immune system and promote its anti-cancer action. Since these agents do not have an anti-mitotic action, they should not cause damage to spermatogenesis. However, no specific studies on human fertility have been conducted before drug registration. In fact, based only on pre-clinical studies, fertility-lowering effect of the BRAF/MEK inhibitors cannot be excluded. Potential endocrine autoimmune-related adverse events which could alter the hypothalamic-pituitary-gonadal axis such as hypophysitis, could impair spermatogenesis. These potential harmful effects should not be overlooked when counselling patients. Study design, size, duration Male patients scheduled for immunotherapies for melanoma were prospectively recruited at National Cancer Institute in Milan, Italy, between March 2020 and April 2023. Patients were counselled by a reproductive medicine specialist and offered to cryopreserve semen before immunotherapies. A semen analysis was also proposed 6-8 months after the initiation and 6-8 months after the end of immunotherapies. The primary outcome was to compare semen variables before, during and after immunotherapies. Participants/materials, setting, methods All patients underwent therapy with Nivolumab or Dabrafenib for 12 months.Semen samples were all cryopreserved and analysed by a single biologist at the Infertility Unit of Policlinico in Milan. Data are reported as median [Interquartile range-IQR] or number (percentage). Main results and the role of chance Twenty-three men operated on for melanoma and scheduled for immunotherapy were recruited. The age of patients at cryopreservation was 33 years [29–39]. An average of 12 [10-12] sperm paillettes were cryopreserved per patient. Total sperm count and total progressive motile sperm count were 126 millions [75–246] and 90 millions [38–154], respectively. Three patients were lost to follow-up and two patients died after cryopreservation. Twelve patients (52%) returned for a semen analysis during oncological treatment. After a median time of 9 months [8-12] of immunotherapy, a reduction in all semen variables was noted, particularly in total sperm count (77 million [49-189], p = 0.05 compared to basal condition) and the total count of progressive spermatozoa (34 million [23-77], p = 0.02 compared to basal condition). No differences were observed in morphology. Ten (43%) patients returned after the end of immunotherapies. One patient died before completing the follow-up. A recovery of all sperm variables compared to the cryopreserved sample was observed. Total sperm count and total motile sperm count were 190 millions [107–320] and 79 millions [34–140], respectively (p=ns). Two patients thawed their cryopreserved semen for an IVF cycle during immunotherapy. No pregnancy was achieved. Limitations, reasons for caution Our study evaluates male fertility only in terms of semen quality. Alterations of the hypothalamic-pituitary-gonad axis, such as the increase of autoimmune phenomena, have not been studied. Furthermore, the small sample size of our study is a limit. Wider implications of the findings Our study evaluates male fertility only in terms of semen quality. Alterations of the hypothalamic-pituitary-gonad axis, such as the increase of autoimmune phenomena, have not been studied. Furthermore, the small sample size of our study is a limit. Trial registration number not applicable

Best Practice Recommendations for Infertility Management.

The objective of this document is to provide guidance to the infertility specialist, gynecologist, embryologist, and counselors on the management of sub-fertility and brief them with the recent advances in the field. These recommendations will aid the aforementioned healthcare professionals in everyday clinical decisions about appropriate and effective care of their patients with the best available evidence. Extensive deliberations, discussion, and brainstorming was done between different reproductive medicine (RM) specialists, to develop the recommendations. A systematic review of the literature published up to June 2019 was carried out using PubMed and Cochrane Collaboration Library. International guidelines, cohort studies, case series, observational studies, and randomized controlled trials currently available in the literature were reviewed. Indian data whatever available was also reviewed. Primary meetings were held with leading reproductive medicine specialists. Each topic was brainstormed on by a group of reproductive medicine experts, who then prepared the first draft of the recommendation. These recommendations then were reviewed by Dr. Jaideep Malhotra, Dr. Gouri Devi, and Dr. Madhuri Patil along with the chief co-ordinator of each consensus to finalize the final draft. From the literature and discussion of the available evidence, several topics were identified for which evidence is inconsistent, insufficient, or non-existing. For the benefit of couples undergoing several treatments, the working committee recommends that future research, where possible in well-designed RCTs, will help in establishing evidence for a particular practice. In the Indian context, one also needs to take into consideration facilities and options available, cost, lack of insurance coverage, experimental nature of some advanced techniques used.

The Possible Role of Prescribing Medications, Including Central Nervous System Drugs, in Contributing to Male-Factor Infertility (MFI): Assessment of the Food and Drug Administration (FDA) Pharmacovigilance Database.

A wide range of medications may have a possible role in the development of male-factor infertility (MFI), including various antineoplastic agents, testosterone/anabolic steroids, immunosuppressive drugs/immunomodulators, glucocorticosteroids, non-steroidal anti-inflammatory drugs, opiates, antiandrogenic drugs/5-alpha-reductase inhibitors, various antibiotics, antidepressants, antipsychotics, antiepileptic agents and others. We aimed at investigating this issue from a pharmacovigilance-based perspective. The Food and Drug Administration (FDA) Adverse Event Reporting System (FAERS) database was queried to identify the drugs associated the most with MFI individual reports. Only those drugs being associated with more than 10 MFI reports were considered for the disproportionality analysis. Proportional Reporting Ratios (PRRs) and their confidence intervals were computed for all the drugs identified in this way in January 2023. Secondary, 'unmasking', dataset analyses were carried out as well. Out of the whole database, 955 MFI reports were identified, 408 (42.7%) of which were associated with 20 medications, which had more than 10 reports each. Within this group, finasteride, testosterone, valproate, diethylstilbestrol, mechloretamine, verapamil, lovastatin and nifedipine showed significant levels of actual disproportionate reporting. Out of these, and before unmasking, the highest PRR values were identified for finasteride, diethylstilbestrol and mechloretamine, respectively, with values of 16.0 (12.7-20.3), 14.3 (9.1-22.4) and 58.7 (36.3-95.9). A variety of several medications, a number of which were already supposed to be potentially linked with MFI based on the existing evidence, were associated with significant PRR levels for MFI in this analysis. A number of agents which were previously hypothesized to be associated with MFI were not represented in this analysis, suggesting that drug-induced MFI is likely under-reported to regulatory agencies. Reproductive medicine specialists should put more effort into the detection and reporting of these adverse drug reactions.

Relugolix combination therapy and symptoms of uterine myomatosis – selected case reports of indication spectrum and treatment outcomes

Summary: Objective: An illustrative review of the indications for relugolix combination therapy (RCT) in the management of symptoms associated with uterine myomatosis. Methods: A set of annotated case reports from outpatient and clinical practice. Results: The fi le includes a non-invasive methodology for defining excessive menstrual bleeding using the pictorial bleeding assessment chart (PBAC). It also presents the use of RCT as a fertility-sparing procedure prior to elective myomectomy and the management of isthmic fibroids as an uterine factor of infertility. Cases of RCT of adenomyosis in primary sterility and in extragenital forms of endometriosis are commented. Emergent events associated with complications of myomatosis in pregnancy are represented by a case report of necrotizing diff use myomatosis in puerperium. The differential-diagnostic confusion of adnexal pathology and myomatosis, RCT as a final solution to failed pharmacotherapy, and the alternative of hysterectomy in premenopause illustrate the diverse spectrum of indications for pharmacological treatment, including the possibility of dual therapy with RCT and aGnRH. Conclusion: Relugolix combination therapy as an effective and safe causal treatment expands the therapeutic spectrum and options for reproductive medicine specialists and registering gynaecologists. The availability of conservative treatment in combination with surgical treatment leads to optimalization and greater effectiveness of therapeutic procedures and increased quality of life for women with myomatosis. Key words: relugolix combination therapy – uterine fibroid symptoms

Optimizing the "Time to pregnancy" in women with multiple sclerosis: the OPTIMUS Delphi survey.

The debate on how to manage women affected by multiple sclerosis (MS) during reproductive age is still open, as is the issue of fertility in such patients. Main issue regard the identification of the optimal window for pregnancy and how to deal with medical therapy before and during conception. The aim of this Delphi consensus was to collect the opinions of a multidisciplinary group, involving reproductive medicine specialists and neurologists with experience in the management of multiple sclerosis women with reproductive desire. Four experts plus scientific coordinators developed a questionnaire distributed online to 10 neurologists and later discussed the responses and amended a list of statements. The statements were then distributed via an online survey to 23 neurologists (comprising the first 10), who voted on their level of agreement/disagreement with each statement. Consensus was achieved if agreement or disagreement with a statement exceeded 66%. Twenty-one statements reached consensus after two rounds of voting, leading to the following main recommendations: (1) Fertility evaluation should be suggested to wMS, in case of the need to shorten time to pregnancy and before treatment switch in women on DMTs contraindicated in pregnancy, particularly in case of highly active disease and age > 35 years. (2) ART should not be discouraged in wMS, but the use of DMTs until pregnancy confirmation should be suggested; ART may be considered in order to reduce time to pregnancy in MS women with a reduced ovarian reserve and/or age > 35 years, but in case of an expected poor ART prognosis and the need for more than one ART cycle, a switch to a high-efficacy DMD before ART should be offered. (3) Oocyte cryopreservation may be considered in women with reduced ovarian reserve, with unpredictable time to complete diagnostic workup and achieve disease control; a risk/cost-benefit analysis must be performed in women >35 years, considering the diminished ovarian reserve. This consensus will help MS neurologists to support family planning in wMS, respecting MS therapeutic needs while also taking into account the safety and impact of advancing age on fertility.

The silent world of assisted reproduction: A qualitative account of communication between doctors and patients undergoing in vitro fertilisation in Australia.

In vitro fertilisation (IVF) is now a common assisted reproductive technology (ART) procedure globally, with 8 million children alive today having been conceived utilising IVF. For many patients, IVF is a difficult experience with many discontinuing treatment because of emotional, relationship and financial stress,or intolerable physical side effects of hormone treatments. A qualitative study, in which 31professionals and 25patients from the ART sector in Australia were interviewed. The interviews were analysed using codebook thematic analysis. Our data indicates there are 'silences' within the therapeutic relationship of IVF, which may limit the capacity for patients to prepare emotionally, financially,or medically for the procedure, and may contribute to psychological distress and dissatisfaction with care. These 'silences' include what the patient 'is not told' by their clinician or 'does not hear' and what the patient feels they 'cannot say'. Drawing upon the work of Jay Katz, Charis Thompson,and Miles Little on 'silences' and performance in clinical practice, we argue that although IVF is a complex and multifaceted procedure that is often conducted in a commercial setting, the clinical and therapeutic relationship between doctor and patient remains pivotal to the experiences of patients. The 'silences' within this relationship may impact negatively on decision-making, and on the delivery and experience of care. Careful attention to the realities of IVF treatment in the clinic room (and awareness of the performances that hide them) should allow for more present and compassionate care. Such care may leave patients more satisfied with their experience and their choices, regardless of treatment outcomes. This article draws on interviews with patients who had undergone or were currently undergoing IVF, as well as a range of representatives from the ART community (including reproductive medicine specialists, general practitioners, fertility nurses, counsellors, administrators in ART businessesand embryologists).

Fertility-sparing surgery: a hopeful strategy for young women with cancer.

Fertility preservation in cancer patients is currently based on either assisted reproductive technology or fertility-sparing surgery. Loss of fertility may be caused by excisional surgery associated with an adnexal or uterine pathology or secondary to gonadal insufficiency caused by chemotherapy or radiation. The counseling of these patients is very important, being carried out jointly by the oncologist, gynecologist, and reproductive medicine specialist. Reproductive surgery usually requires avoiding laparotomy to significantly reduce the formation of adhesions and trauma or tissue damage. This is done using standard laparoscopic surgery or robotic surgery (computer-assisted laparoscopy), a method increasingly used and accessible to all specialists who want to maintain the fertility of their patients with various oncological diseases.

P-470 Prediction of the cumulative live birth rate of IVF using a human embryonic stem cells-derived trophoblastic spheroid implantation model

Abstract Study question Can the attachment rate of a human embryonic stem cell-derived trophoblastic spheroids (BAP-EB) onto endometrial epithelial cells predict the cumulative live birth rate of an IVF cycle? Summary answer The BAP-EB attachment rate offers modest prediction of the cumulative live birth rate of women aged ≥35 years undergoing IVF. What is known already Implantation failure is one of the major causes leading to a low IVF success. There is no reliable tool for assessing endometrial receptivity in IVF. Study design, size, duration Prospective observational study of 240 infertile women from 2017 to 2021. Participants/materials, setting, methods Infertile women with regular cycles attending IVF centres were recruited. Endometrial aspirates were collected from a natural cycle one month before IVF for the BAP-EB attachment rate. The cumulative live birth rate of a stimulated cycle and its derived frozen embryo transfer cycles within 6 months of ovarian stimulation were obtained. Main results and the role of chance The BAP-EB attachment rate in women with a cumulative live birth was similar to those who failed to have a live birth. When women were stratified by age into <35 years and ³35 years, the BAP-EB attachment rate was significantly higher only in women aged ³35 years who had a live birth when compared to those without a live birth. The receiver operating characteristic (ROC) curve analysis of BAP-EB attachment rate in predicting cumulative live birth showed the area under the curve (AUC) of 0.559 (95% CI 0.479 – 0.639, p = 0.151), 0.448 (95% CI 0.310 – 0.585, p = 0.461) and 0.613 (95% CI 0.517 – 0.710, p = 0.026) for all ages, age <35 and ≥35 respectively. Limitations, reasons for caution BAP-EB and the isolated endometrial epithelial cells may not fully represent the in vivo developed human blastocysts and endometrial cells, respectively. The in vitro nature of the experiments and the limited sample size in this study may also limit the interpretation of the data. Wider implications of the findings Implantation failure is one of the major reasons contributing to the low success rate of IVF. The BAP-EB-endometrium attachment assay could potentially be used by reproductive medicine specialists to better counsel the couples who fail in IVF treatment. Trial registration number NCT02713854

Ovarian reserve is influenced by ethnicity – a fact, a reproductive medicine specialist should be aware of

Ovarian reserve is influenced by ethnicity – a fact, a reproductive medicine specialist should be aware of

(335) Unconsummated Marriage: Findings and Outcomes of Ccouples Visiting an Andrology Clinic

Abstract Introduction Failure to have a penetrative peno-vaginal intercourse among the heterosexual married couples is termed as unconsummated marriage (UCM). Unheard in most western countries, UM is often seen in culturally conservative countries like India where majority still don't have sexual encounters prior to marriage. Nonconsummation is most commonly due to erectile dysfunction (ED, vaginismus or forced marriage. The management requires an aggressive early treatment otherwise some even end up in divorce. Objective To report the clinical characteristics and outcomes of males visiting Andrology clinic seeking treatment for UCM Methods This is a retrospective study of 62 male patients seeking treatment for UCM who presented to the andrology clinic from Jan 2018 to May 2022. All were subjected through detailed clinical history including patient demographics, physical examination and necessary investigations. Wherever possible, the female partner was also involved for discussion and if found abnormal during clinical history was referred to the female reproductive medicine specialists. Results Of the 62 male patients, majority (56, 90%) complained erectile dysfunction as the cause for UCM. Other causes being lack of anatomical knowledge of intercourse (2/62), vaginal pain while attempting penetration (4/62), performance anxiety (5/62) and forced marriage (4/62). There was overlap of more than 1 cause in few patients. The mean duration of UCM was 12.6 months (range 2-128 months). Of the 62 patients, 13 had master’s degree and 42 had bachelor’s degree. Among the 56 patients with ED, 22/56 had already received sildenafil or/and tadalafil from primary care physician with no success. Dual therapy (simultaneous on-demand sildenafil and daily tadalafil) helped 23/56 males to consummate their marriage. Six males didn’t come for follow-up after 2 visits and even refused to answer our questions on phone. Two males did not seek any further treatment for ED after oral medications failed and proceeded with assisted reproductive techniques to conceive for social reasons. Of the four females with vaginismus, 3 successfully consummated following vaginal dilator therapy and psychosexual counselling, but the remaining 1 proceeded with intrauterine insemination to conceive. Consummation was achieved in 6 men who received intra-cavernosal injection of reconstituted 20mcg alprostadil. Three men consummated following penile prosthesis placement (2 semirigid and 1 inflatable). Two couples divorced as the wives wanted “natural” erections from their husbands and not “medicated” erections. Three couples were in the process of divorce. Twelve of the 62 men were accompanied by their parents or in-laws in their first or second clinical visit. Conclusions As against the usual assumption, UCM is commonly seen even among the well-educated class. UCM should be considered as an andrological emergency and timely intervention is required to prevent termination of marriage. When oral medications and counselling doesn’t work, do not hesitate to start on intra-cavernosal injections and occasionally may be a penile implant surgery. Due to social and familial concerns, few may decide to seek assisted reproductive techniques to conceive without sexual intercourse and the same may be considered. Disclosure No

Obstetrical outcomes of pregnant women 50 years and older compared to those aged 45-49 years: A systematic review and meta-analysis.

In this review, We compared clinical characteristics of pregnant women aged 50 and older with those aged 45-49. Pregnant women ≥45 years are strongly associated with pregnancy-related complications, such as cesarean section rate, gestational hypertension, gestational diabetes mellitus, and preterm birth. Although pregnant women ≥50 years are considered more high-risk, differences in pregnancy outcomes between those over 45 and 50 years of age are unclear. Our source strategy included using PubMed, the Cochrane Central Register of Controlled Trials, and Web of Science databases to include studies published between January 1, 2010 and September 30, 2022. The study population was pregnant women 50 years and older; the control group was pregnant women aged 45-49 years. Primary outcomes were cesarean section, gestational hypertension, gestational diabetes mellitus, and preterm birth. The secondary outcomes were small-for-gestational age, 5-min Apgar score < 7, neonatal intensive care unit admission (as neonatal outcomes), nulliparity, assisted reproductive technology (ART), and multifetal pregnancy (as maternal backgrounds). The incidence of cesarean section, gestational hypertension, and preterm delivery was significantly higher in those 50 years and older; however, significant differences disappeared when pooled analyses were limited to singleton pregnancies. ART was significantly more likely to be used for conception of pregnant women ≥50 years. Infants of women ≥50 years were more likely to be admitted to NICUs. The differences in outcomes between the two groups are obviously influenced by multiple pregnancies, therefore, reproductive medicine specialists should aim for singleton pregnancies in ART.

Expert consensus on the morphological evaluation of human cleavage-stage embryos and blastocysts.

Expert consensus on the morphological evaluation of human cleavage-stage embryos and blastocysts.

Long-Term Fertility Function Sequelae in Young Male Cancer Survivors.

With advances in cancer treatment, such as cytotoxic chemotherapy and radiotherapy, grave new sequelae of treatment have emerged for young cancer survivors. One sequela that cannot be overlooked is male infertility, with reportedly 15% to 30% of cancer survivors losing their fertility potential. Cytotoxic therapy influences spermatogenesis at least temporarily, and in some cases, permanently. The degree of spermatogenesis impairment depends on the combination of drugs used, their cumulative dose, and the level of radiation. The American Society of Clinical Oncology has created an index to classify the risks to fertility based on treatment. Medical professionals currently use this risk classification in fertility preservation (FP) programs. FP programs are currently being promoted to prevent spermatogenesis failure resulting from cancer treatment. For patients who are able to ejaculate and whose semen contains sperm, the semen (sperm) is cryopreserved. Moreover, for patients who lack the ability to ejaculate, those with azoospermia or severe oligozoospermia, and those who have not attained puberty (i.e., spermatogenesis has not begun), testicular biopsy is performed to collect the sperm or germ cells and cryopreserve them. This method of culturing germ cells to differentiate the sperm has been successful in some animal models, but not in humans. FP has recently gained popularity; however, some oncologists and medical professionals involved in cancer treatment still lack adequate knowledge of these procedures. This hinders the dissemination of information to patients and the execution of FP. Information sharing and collaboration between reproductive medicine specialists and oncologists is extremely important for the development of FP. In Japan, the network of clinics and hospitals that support FP is expanding across prefectures.

Клинический случай диагностики и комплексного лечения наружного генитального эндометриоза у пациентки с бесплодием

The purpose of the article: to present a clinical case of diagnosis and complex treatment of endometriosis in a patient with infertility. Key points: the problem of infertility associated with endometriosis is extremely relevant. An important direction is the search for the most effective non-invasive method for diagnosing endometriosis, because performing laparoscopy only for diagnostic purposes leads to an increase in the number of unnecessary surgical interventions. The formation of a unified management strategy for patients with endometriosis is another task that reproductive medicine specialists face. Treatment of infertility and pain in endometriosis cannot always be carried out simultaneously. Conclusion. Magnetic resonance imaging (MRI) can be a key method of non-invasive diagnosis of endometriosis. An integrated approach to the treatment of infertility and endometriosis allows to determine the tactics, stop the pain syndrome, and achieve the desired pregnancy. Key words: clinical case, endometriosis, infertility treatment, reproductive medicine, ART.

Freezing techniques as fertility preservation strategies: a narrative review

Advances in the development of new chemotherapy and radiotherapy regimens have significantly improved the survival of cancer patients but many of these treatments have detrimental effects on gonadal function. These treatments may cause premature ovarian failure in females and azoospermia in males. Non-oncological conditions may also require therapies that put women's and men´s reproductive potential at risk. Moreover, an increasing number of women today decide to postpone maternity beyond the age of 35 due to social reasons with a possible affectation of future fertility due to the effect of age. The development and evolution of assisted reproductive techniques offer these patients new alternatives to preserve their fertility. The objective of this review is to describe the different options of fertility preservation. Oocyte vitrification for female and sperm banking for male are the first line for fertility preservation at the present time. Other techniques such as ovarian and testis tissue preservation, in vitro maturation of gametes, pharmacological protection (GnRH agonists and antiapoptotic agents) and surgical treatments (oophoropexy, selective radical trachelectomy) will be described. One of the most important steps in optimizing the results of these fertility preservation procedures in cancer patients is the need for prompt and timely referral to reproductive medicine specialists. Fertility preservation should be integrated as part of the oncological healthcare. Optimal counselling from healthcare professionals should always be present.

Fertility preservation counselling for women with endometriosis: a European online survey.

Endometriosis is a common cause for infertility. Decreased ovarian reserve due to pathology or surgical management can reduce the chances of natural pregnancy and limit the effectiveness of controlled ovarian stimulation during fertility treatment. Cryopreservation of oocytes or ovarian cortex prior to surgery or before loss of follicular capital is a strategy to preserve fecundity. An online survey was sent to reproductive specialists and gynecological surgeons representing major centers of reproductive medicine in Europe to investigate current fertility preservation practices for endometriosis patients. Of 58 responses, 45 (77.6%) in 11/13 countries reported the existence of endometriosis management guidelines, of which 37/45 (82.2%) included treatment recommendations for infertile patients. Most centers (51.7%) reserved fertility counselling for severe endometriosis (large endometriomas with or without deep endometriosis) while 15.5% of centers did not offer fertility preservation for endometriosis. To address non-uniformity in available guidelines and the diversity in fertility preservation practices, we propose an algorithm for managing patients with severe endometriosis most likely to be impacted by reduced ovarian reserve. Improved awareness about the possibilities of fertility preservation and clear communication between gynaecological surgeons and reproductive medicine specialists is mandatory to address the unmet clinical need of preventing infertility in women with endometriosis.

The management of haemoglobinopathies in pregnancy and childbirth

Key Content The haemoglobinopathies encompass a complex collection of red blood cell disorders that are responsible for considerable morbidity and mortality in women and their unborn children. Sickle cell disease and the thalassaemias are the commonest haemoglobinopathies encountered in UK clinical practice. A consistent standard of care will enable women with haemoglobinopathies to have a pregnancy that is as safe as possible, with good outcomes and minimal long‐term effects on their health and the health of their babies. The most effective way to deliver a consistent standard of care for these women is via the multidisciplinary team (MDT). The MDT should include a haematologist, cardiologist, maternal medicine obstetrician, specialist midwife, reproductive medicine specialist and a nurse specialist. The care of these women, within the MDT, should start with pre‐conception advice and continue through their antenatal care, intrapartum support and finally, provide postnatal considerations including contraception advice. Learning Objectives To understand the inheritance, incidence, detection and pathophysiology of the commonest haemoglobinopathies. To appreciate the role of pre‐conception advice and prenatal diagnosis in the management of women with a haemoglobinopathy. To appreciate the multidisciplinary team approach in managing women with these conditions. Ethical Issues Prenatal diagnostic techniques can be used to diagnose an affected pregnancy; however, diagnosis after conception means families must address the option of terminating the pregnancy. This requires expert counselling to minimise long‐term sequelae. The definitive prenatal tests – chorionic villus sampling and amniocentesis – are both associated with a small risk of miscarriage. Non‐invasive free fetal DNA (ffDNA) tests that will minimise the risk of testing to the developing fetus are being developed, but use of these tests will still require expert counselling both before and after a test is taken.

Reproductive Issues in Long-Term Surviving Patients following Therapy for Hodgkin's Disease in the Republic of North Macedonia: Risks of Infertility According to First-Line Treatment Regimens.

Infertility as a consequence of therapy presents a high psychosocial burden for HL patients. In the cohort of our analyzed patients, within the post-ABVD surviving patients, alterations of the spermogram were documented in a total of 6.1% of the male patients and 5.4% of the female patients developed amenorrhea. On the other hand, within the subgroup of surviving patients following BEACOPP chemotherapy, 60% of the male patients manifested defects in their spermogram, and as high as 28.6% of the female survivors reported loss of their monthly cycle. It has been reported on several occasions that even prior to treatment, the sperm of HL patients manifests poorer quality characteristics when analyzed against control specimens from healthy male donors. The analyzed results in ABVD-treated male HL patients confirm ABVD to be a safe regimen for males of all age categories, as well as for female patients under the age of thirty. In women above the age of 30, the infertility risk rate is relatively low (14%), which leaves the decision of preserving fertility to themselves. For all BEACOPP-treated female, as well as male patients, a consult with a reproductive medicine specialist is warranted prior to therapy, due to the high infertility risk, and the final decision should be made on an individual basis.